Differential reinforcement of other behavior (DRO) to reduce aggressive behavior following traumatic brain injury.

One adult with traumatic brain injury kept hitting and kicking staff during rehab.

The team used DRO. When the man went five minutes with no aggression, he got praise and a small snack.

They tracked three separate aggressive acts across days using a multiple-baseline design.

Aggression dropped up to 74 percent.

The improvement held one month later without extra drugs.

Medical tasks that used to trigger hits could now be done safely.

Cohen et al. (1990) tried DRO alone with two aggressive adults who had intellectual disability. DRO plus reprimands did almost nothing. Only when they added a short time-out did aggression fall.

Linton et al. (2025) saw the same story on a preschool playground. DRO alone helped only one of four kids. Adding a 30-second time-out cleared the behavior for the rest.

So Byrne et al. (2000) looks like an outlier: pure DRO worked without any time-out. The difference is the participant. A single adult with TBI and no long history of severe aggression may need less than kids or adults with lifelong patterns.

Jessel et al. (2016) review agrees: check the individual case first, then layer in time-out only if DRO alone fails.

You now have a quick rule for rehab or clinic settings. Start with simple DRO when aggression is new and tied to brain injury. Watch the data like a hawk. If responding flattens after a week, add a brief time-out or other aid instead of abandoning the plan. This keeps staff safe without rushing to medication.